烧伤治疗中的连续周围神经阻滞:对 281 名烧伤患者的治疗效果和并发症的回顾性研究。

IF 5.1 2区 医学 Q1 ANESTHESIOLOGY Regional Anesthesia and Pain Medicine Pub Date : 2024-10-31 DOI:10.1136/rapm-2024-105930
Louis Perkins, Gerardo Pedroza, Max Soghikian, Jarrett E Santorelli, Laura N Haines, Kevin Box, Jeanne G Lee, Rodney Gabriel, John J Finneran
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引用次数: 0

摘要

背景:关于在急性烧伤患者中使用连续性外周神经阻滞的文献很少,而这些患者可能面临较高的导管相关并发症风险,包括感染。我们试图描述本中心在对烧伤患者进行疼痛治疗时使用连续性周围神经导管的经验和感染率:我们开展了一项回顾性观察研究,研究对象包括 2018 年 1 月至 2023 年 7 月期间入住美国烧伤协会认证的区域烧伤中心、因急性烧伤接受连续性周围神经阻滞治疗的所有患者:研究队列中有 281 名患者,他们接受了 484 根会阴导管。其中 52% 为男性,中位年龄为 39 岁(IQR 30-55)。在六名不同患者(2.1%,95% CI 0% 至 3.8%)的六根会阴导管中发现了导管相关感染(经主治医生临床诊断,需要使用抗生素或手术清创治疗)(1.2%,95% CI 0% 至 2.2%)。烧伤的体表总面积中位数为 5%(IQR 2-9%),20% 的患者为全层烧伤。最常用的导管是锁骨下导管(49%)、腘坐骨导管(29%)、股导管(19%)和内收管导管(17%)。三分之一(33%)的患者不需要在手术室进行清创,因为阻滞为床边清创提供了足够的镇痛效果。导管使用时间的中位数为 6 天(IQR 4-8)。没有神经损伤或毒性、血管损伤或局麻药全身毒性的病例记录:结论:在我们的临床实践中,急性烧伤患者使用连续性硬膜外导管的感染率与其他手术人群相当。
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Continuous peripheral nerve blocks for burn management: a retrospective study of outcomes and complications in 281 burn patients.

Background: There is scarce literature regarding the use of continuous peripheral nerve blocks in acute burn patients, who may be at higher risk for catheter-related complications, including infection. We sought to describe our center's experience and infection rate with continuous perineural catheters in the setting of pain management for patients suffering from burns.

Methods: A retrospective observational study was performed including all patients admitted to an American Burn Association-verified regional burn center between January 2018 and July 2023 who received a continuous peripheral nerve block for an acute burn injury.

Results: There were 281 patients in the study cohort who received 484 perineural catheters. The cohort was 52% men with a median age of 39 years (IQR 30-55). A catheter-associated infection, defined as a clinical diagnosis by the treating physicians requiring the need for treatment with antibiotics or surgical debridement, was identified in six perineural catheters (1.2%, 95% CI 0% to 2.2%) involving six different patients (2.1%, 95% CI 0% to 3.8%). The median total body surface area burned was 5% (IQR 2-9%) and 20% of patients had full-thickness burns. The most commonly used catheters were infraclavicular (49%), popliteal sciatic (29%), femoral (19%), and adductor canal (17%). One-third (33%) of patients did not require operating room debridement as the block provided sufficient analgesia for bedside debridement. The median duration of catheter use was 6 days (IQR 4-8). There were no documented cases of nerve injury or toxicity, vascular injury, or local anesthetic systemic toxicity.

Conclusions: In our practice, continuous perineural catheters in the setting of acute burns are associated with an infection rate comparable to other surgical populations.

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来源期刊
CiteScore
8.50
自引率
11.80%
发文量
175
审稿时长
6-12 weeks
期刊介绍: Regional Anesthesia & Pain Medicine, the official publication of the American Society of Regional Anesthesia and Pain Medicine (ASRA), is a monthly journal that publishes peer-reviewed scientific and clinical studies to advance the understanding and clinical application of regional techniques for surgical anesthesia and postoperative analgesia. Coverage includes intraoperative regional techniques, perioperative pain, chronic pain, obstetric anesthesia, pediatric anesthesia, outcome studies, and complications. Published for over thirty years, this respected journal also serves as the official publication of the European Society of Regional Anaesthesia and Pain Therapy (ESRA), the Asian and Oceanic Society of Regional Anesthesia (AOSRA), the Latin American Society of Regional Anesthesia (LASRA), the African Society for Regional Anesthesia (AFSRA), and the Academy of Regional Anaesthesia of India (AORA).
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